223671 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 367399 Page 1 of 1
ONE CIVIC SQUARE TITLE LLC
CARMEL, INDIANA 46032 14711 W.112TH STREET CHECK AMOUNT: $189.99
LENEXA KS 66215 CHECK NUMBER: 223671
CHECK DATE: 8127/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4467099 25386 P04921270001 189 . 99 MMA HEAVY BAG
14711 West 112th Street INVOICE
Lenexa,Kansas 66215
T1 (800)999.1213 PLEASE REMIT TO:
Fax:(913)492-7546 TITLE BOXING
14711 WEST 112TH STREET
LENEXA,KANSAS 66215
SHIP TO(IF OTHER THAN"SOLD TO")
YOUR ACCOUNT NO. F
PLEASE REFER TO YOUR ACCOUNT • OUR •
ORDER NO.IN ALL COMMUNICATIONS REGARDING THIS INVOICE
0012986899
TOLD �ERESA ANDERSON
CARMEL POLICE DEPT L
3 CIVIC SQUARE
CARMEL, IN 46032
25386 08/02/13
L YOUR PURCHASE ORDER NUMBER AND DATE
OUR INV�ORDER NO.
Payment Due by 09/05/13
P049212700018 08/06/13 UPS GROUND 08/05/13
1 1 MMCTHB 100 TITLE MMA BANANA HEAVY BAG 100 LBS 149.99 149.99
PO#25386
ACCOUNTS 30 DAYS ANDOVER ARE SUBJECT TO A FINANCE CHARGE OF 1 112%PER MONTH WHICH •
IS AN ANNUAL PERCENTAGE RATE OF 18%TO BE APPLIED TO THE UNPAID BALANCE.
40.00 !
********* R E P R I N T ********
ORIGINAL
PLEASE RETURN BOTTOM PORTION WITH PAYMENT.-
C O INDIANA RETAIL TAX EXEMPT PAGE
1� o Carmel CERTIFICATE NO.003120155 002 0 1..� 11 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
7130120`13
Title, LLC Camel Pollee Department
VENDOR SHIP 3 Civic Square
TO
14791 W. ii2th Street Carmel, IN 46M
LoI @xa, KS 6V15 (317)671-25%9
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
Account UNITOF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account
1 Each Title MMA Heavy Bag $149.99 $149.99
1 Eact slipping charges $40.00 $40.00
Sub Total: $189.5
p
•
J 4V ell
R � m
ra
Send Invoice To:
Carmel Police Department
Attn: Tessa Anderson
3 Civic Square
Camel, IN 46032= PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT
Carinei Police Dept. �t `> PAYMENT $189.99
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
�• NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY/THAT t THERE CIS-AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID. -
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUSTAPPEAR ON ALL ORDERED BY 1 ! 1
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE 916f of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. V '
8 6 CLERK-TREASURER
DOCUMENT CONTROL NO. A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO._-...._._..__-._-_.WARRANT NO.......-_......_-._....
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT# I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
receivedexcept.._.--....... - ................._..--..-....._... --._..-..--..--... --.-..--.....
.20
.................--.................................................................................................................................................................---......._..............................................
Signature
...................._.........................................--.....................................................................................................................................-. _.-.........................
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
-VOUCHER NO. WARRANT NO.
ALLOWED 20
Title, LLC
IN SUM OF $
14711 W. 112th Street
Lenexa, KS 66215
$189.99
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25386 I P0492127000181 44-670.99 I $189.99 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday, August 22, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
08/06/13 P049212700018 punching bag $189.99
I hereby certify that the attached invoice(s), or bill(s), is (are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer